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The muscle-sparing thoracotomy in infants and children
1Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
A muscle-sparing thoracotomy in children minimizes chest wall deformities and improves outcomes. This surgical approach preserves muscles and nerves, reducing long-term complications without compromising exposure.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Skeletal Deformities
Background:
- Major thoracotomies can cause significant chest wall, breast, shoulder, and spine deformities in children.
- These deformities are often exacerbated by the natural growth process.
- Existing surgical techniques may lead to muscle damage, nerve injury, and rib complications.
Purpose of the Study:
- To advocate for the routine use of a muscle-sparing thoracotomy in infants and children.
- To present a surgical technique that minimizes post-thoracotomy deformities.
- To demonstrate that reduced sequelae can be achieved without sacrificing surgical exposure.
Main Methods:
- A specific lateral thoracotomy technique is described.
- Key steps include precise incisions, muscle retraction (latissimus dorsi, serratus anterior), and careful rib approximation.
- A pericostal suture technique is employed to avoid neurovascular bundle compression.
Main Results:
- The described muscle-sparing thoracotomy technique aims to prevent or minimize chest wall, breast, shoulder girdle, and spine deformities.
- Benefits include reduced postoperative pain and improved respiratory function.
- Preservation of muscle and nerve integrity is a primary goal.
Conclusions:
- Routine implementation of muscle-sparing thoracotomy in pediatric patients is recommended.
- This approach offers a viable solution to mitigate long-term sequelae of major thoracotomies.
- The technique balances effective surgical exposure with improved patient outcomes and reduced deformity.
Abstract:
Deformities of the chest wall, breast, shoulder girdle, and spine are well-documented sequelae of major thoracotomies that transect muscles, divide major motor nerves, resect ribs, or cause them to fuse. These deformities are probably aggravated by the growth process. This is why we make a plea for the routine use, in infants and children, of a muscle-sparing thoracotomy that will minimize these sequelae without sacrificing exposure. Major (lateral) thoracotomy by this technique involves these steps: (1) creating a transverse incision below the tip of the scapula, or a vertical axillary incision; (2) elevating the skin flaps to expose the muscles; (3) retracting the latissimus dorsi posteriorly; (4) retracting the serratus anterior and scapula superiorly; (5) disinserting the lower origins of the serratus if required only; (6) opening the desired intercostal space; (7) reapproximating the ribs without crowding, using a pericostal suture that is passed along the inferior rib subperiosteally, to avoid any compression on the neurovascular bundle; and (8) allowing the muscles to fall back into place, reattaching the serratus insertions as indicated. Lessened postoperative pain and improved respiratory function are additional benefits.